Eligibility Determination

Eligibility Determination AzEIP Process and Procedures for Eligibility Determination; 2008

Definitions • The team must first determine that a child is eligible for AzEIP • Secondly, and as important, the team gathers appropriate information to facilitate simultaneous agency eligibility • ASDB • DDD

Definitions • AzEIP eligibility • Developmental Delay • Established Condition • Use of Informed Clinical Opinion

AzEIP Eligibility • Developmental Delay • A child from birth to 36 months will be considered to exhibit developmental delay when that child has not reached 50% of the developmental milestones expected at his/her chronological age, in one or more of the following domains • Physical: fine, gross, vision and hearing • Cognitive • Language/communication • Social or emotional • Adaptive

AzEIP eligibility • Established Condition • Established conditions that have a high probability of developmental delay include, but are not limited to: • Chromosomal abnormalities • Metabolic disorders • Hydrocephalus • Neural tube defects (spina bifida) • Intraventricular hemmorhage (grade 3 or 4) • Periventricular leukomalacia • Cerebral palsy • Significant auditory impairment • Significant visual impairment • Failure to thrive • Severe attachment disorders

AzEIP Eligibility • Use of Informed Clinical Opinion • Each multidisciplinary team member applies his/her own developmental expertise in interpreting observation, interaction, evaluation and assessment, and records to make a recommendation about the child’s eligibility • Multidisciplinary team must reach consensus regarding the child’s eligibility for AzEIP

AzEIP Eligibility • The State’s definition of “eligible child” DOES NOT include children who are at risk of having substantial delays if early intervention services are not provided.

Agency Eligibility • Only Agency personnel can determine Agency eligibility • Simultaneous determinations are encouraged at the point of evaluation • Team’s responsibility to provide appropriate, accurate information to facilitate the decision making process • Team needs to understand Agency criteria to do this well

ASDB Eligibility • Child under the age of three years • Hearing: • Hearing Impairment means a permanent, bi-lateral loss of hearing acuity, as determined by an audiologist. • Vision: • Visual impairment means a permanent, bilateral loss in visual acuity or a loss of visual field, as determined by an ophthalmological evaluation, that interferes with the child’s development

ASDB eligibility • Key elements: • Bi-lateral, permanent • Diagnosed by appropriate professional • ASDB frequently receives direct referrals • ASDB contacts the IPPteam/team-based contractor as appropriate to complete the initial evaluation and coordinate the IFSP • ASDB sometimes completes the Initial Planning Process independently and sometimes contacts the team

DDD eligibility • A child under the age of 6 may be eligible for services if there is a strongly demonstrated potential that the child is or will become developmentally disabled (Cognitive Disability, CP, Epilepsy or Autism) as determined by appropriate tests. (A.R.S. 36-551)

DDD eligibility • Have a diagnosis of Cerebral Palsy, Epilepsy, Autism or Cognitive Disability or • Have an Established Condition which puts them “At Risk” for one of the four developmental disabilities or • Have demonstrated a Significant Developmental Delay that indicates the potential for one of the four developmental disabilities

DDD eligibility • DDD defines Developmental Disability as: • 1. Cognitive Disability; • 2. Cerebral Palsy; • 3. Epilepsy; or • 4. Autism

DDD eligibility • Pervasive Developmental Disorder • When diagnosed by a qualified professional, PDD is a known risk factor for later diagnosis of Autism • Documentation of the diagnosis of PDD is sufficient for DDD eligibility

DDD eligibility • “At Risk” Conditions that may lead to one of the four developmental disabilities • Congenital infections such as rubella, CMV • Metabolic diseases with known mental retardation high-risk association, such as maple syrup urine or untreated hypothyroidism with high risk for cognitive disability • The parent or primary caregiver has a developmental disability, and there is a likelihood that without early intervention services the child will become developmentally disabled

DDD eligibility • “At Risk” Conditions that may lead to one of the four developmental disabilities • Other syndromes with known mental retardation high-risk association - Cornelia de Lange, Prader-Willi Syndrome • Alcohol or drug-related birth defects - Fetal Alcohol Syndrome (FAS) • Birth weight less than 1000 grams 2.2LBS with neurological impairment or significant medical involvement • Neonatal Seizures (afebrile, i.e., not from a fever) • Post natal traumatic brain injury

DDD eligibility • “At Risk” Conditions that may lead to one of the four developmental disabilities • Hydrocephaly, Microcephaly, Meningitis, Encephalitis • Spina bifida with evidence of hydrocephalus or Arnold-Chiari malformation • Intraventricular Hemorrhage, Grade 3 or 4 • Periventricular Leukomalacia • Chromosomal abnormalities with high risk of leading to a developmental disability -EX Down Syndrome, Fragile X

DDD eligibility • These conditions require from DDD a review of medical records and/or delays documented on a developmental assessment : • Fetal Drug Exposure • Fetal Alcohol Effects • Developmental Delay • Failure to Thrive (Diagnosis alone is not sufficient; must relate to one of the four)

DDD eligibility “Significant Developmental Delay” that may lead to one of the four developmental disabilities • The child hasnot reached 50% (2 standard deviations) of the developmental milestones* expected at his/her chronological age in one of the following domains: OR • The child has not reached 75% of the developmental milestones* expected at his/her chronological age in two or more of the following domains:

DDD eligibility “Significant Developmental Delay” in one or more of the following domains that may lead to one of the four developmental disabilities : Physical development (fine and gross motor skills) Cognitive development Language/Communication development Self-help/Adaptive skills Social-Emotional skills Must demonstrate delay will likely lead to a disability as defined by DDD

DDD eligibility • Additional Criteria • Informed clinical opinion states the child is “at risk of developing a delay” as defined by DDD if services are not provided. • Based on a norm referenced or criterion referenced, culturally appropriate and professionally accepted developmental assessment tool. • Children with expressive language delays only usually do not qualify for DDD. • Definition of delay is one of the four.

Dual Diagnosis • Child may be eligible for both ASDB and DDD • Team decision regarding primary agency and service coordination duties

Eligibility Process • Background • Initial Steps • Evaluation • Eligibility • Next Steps

Eligibility Process - Background • Guiding Principals • Children develop within the context of their everyday interactions, routines, and activities. Their developmental processes impact how they interact with and function in their family and community life

Eligibility Process - Background • Guiding Principals • During the earliest years of life, children’s learning about themselves and the world around them occurs during social interactions with parents and other family members as part of daily routines, such as getting dressed and eating dinner.

Eligibility Process - Background • Guiding Principals • Development is a highly integrated process, rather than a series of discrete, sequential steps.

Eligibility Process –Initial steps • Referrals come from multiple sources directly to the team • Within 2 days, the SC makes initial contact with the family • Within 10 days, the SC conducts an initial visit • Explains early intervention • Completes initial planning pages of IFSP • Conducts screening using an approved tool

Eligibility Process –Initial steps • Screening means formal and informal procedures to identify concerns in a child’s development that indicates a need for an evaluation to determine eligibility for early intervention services.

Eligibility Process –Initial steps • Screening may include observations, family interviews, review of medical or developmental records, or administration of specific (approved) screening instruments • Tools may or may not be used in screening

Eligibility Process –Initial steps • If child “passes” the screening • PWN of “not going to eval” • Info on other community programs that may be of interest to the family ie EHS • If child “fails” the screening • Consent to eval • Consent to obtain records

Eligibility Process –Initial steps • SC notifies the multidisciplinary team for need of evaluation • SC shares information with the multidisciplinary team members to plan the evaluation • SC shares information with ASDB and/or DDD if appropriate

Eligibility Process –Evaluation • The Multidisciplinary Team for the evaluation decides which are the most appropriate Multiple Sources of Information to be used to Determine AzEIP Eligibility and Support the Simultaneous Decision of DDD or ASDB Eligibility.

Eligibility Process –Evaluation • The multidisciplinary team must include a minimum of two disciplines • Selected from the core team • OT • PT • SLP • DSI

Eligibility Process –Evaluation • Evaluations are conducted for two purposes only • To determine a child’s initial eligibility for AzEIP • To re-determine a child’s continuing eligibility for the program

Eligibility Process –Evaluation • Evaluation includes: • A review of existing information about the child • A decision regarding the need for additional information • If necessary, the collection of additional information • A review of all information about the child and a determination of eligibility for services through AzEIP, ASDB and/or DDD

Eligibility Process –Evaluation • If child has an identified Established Condition: • Child is eligible for AzEIP • Multidisciplinary team conducts a comprehensive assessment to support the development of the initial IFSP • Uses, at a minimum, one approved broad spectrum tool which meets requirements for determining a child’s present levels of development and completion of the Child Indicator Summary Form

Eligibility Process –Evaluation • If the child does not have an established condition, but the team suspects that the child may have a developmental delay: • The team must plan and conduct a multidisciplinary evaluation using approved evaluation tools to address AzEIP eligibility criteria • Select, at a minimum, one approved broad spectrum tool which meets requirements for determining a child’s present levels of development and completion of the Child Indicator Summary Form

Eligibility Process –Evaluation • Using combinations of tools: • Use of at least one broad spectrum tool that covers ALL areas of development is required • Programs may add additional tools, such as a discipline specific tool to either the evaluation or assessment process to compliment the questions and concerns of the family

Eligibility Process –Evaluation Using combinations of tools: • Combinations of tools in order to ensure that ALL areas of development are addressed is not acceptable, i.e. HELP cognitive with complete Vineland • When combinations include the use of a broad spectrum tool and a discipline-specific tool, the area addressed by the discipline specific tool does not need to be repeated on the broad spectrum tool. • For example, using a HELP (broad spectrum tool) and a PLS-4 (communication tool) the team does not need to complete the communication section on the HELP

Eligibility Process –Evaluation • Additionally, • Evaluation tools must be interpreted as designed • Generally two standard deviations below the mean or an age equivalent indicating 50% delay meets AzEIP eligibility criteria • Informed clinical opinion must also be used in every eligibility determination

Eligibility Process –Evaluation I { normal range } I roughly 50% delay

Eligibility Process –Evaluation • Multidisciplinary team • Discusses evaluation results with family • Makes a determination of AzEIP eligibility • ASDB and or DDD simultaneous eligibility determined by state agency personnel • Completes the AzEIP Developmental Evaluation Report and the AzEIP Eligibility Outcome Summary Form

Eligibility- Documentation • Developmental Evaluation Report Form • Team Members • Evaluation Procedures • Background Information • Test Scores • Birth/Medical/Developmental History • Summary of Observations and Eval Results • Team Signatures

Eligibility Documentation • AzEIP Eligibility Outcome Form • Summary of AzEIP and Agency eligibility decision • Done only during the Initial Planning Process • Part of the IFSP

Eligibility Decision • If not eligible… • SC provides PWN/letter of ineligibility to family • SC explores other community resources with the family • If eligible • SC provides PWN/letter of eligibility to family • The team determines what additional information is needed and who is the best team member to gather that information: Initial Assessment

Eligibility Complete-Next Steps • Assessment: the ongoing procedures used throughout the child’s period of eligibility to identify • the child’s unique strengths and needs and services appropriate to meet those needs; • the resources, priorities and concerns of the family and the identification of supports and services necessary to enhance the family’s capacity to meet the developmental needs of their child.

Eligibility Complete-Next Steps • Assessment process includes: • On-going discussion with the family about their priorities, resources and concerns relevant to their child’s development • Gathering information from multiple sources to support IFSP development, and once developed, assessing and documenting progress toward IFSP outcomes • Coordinating with appropriate team members to address families concerns • Development of a comprehensive, integrated summary of the child’s development

Eligibility Complete-Next Steps • Development of the IFSP • Within 45 days from referral, the team has completed screening, evaluation, eligibility determination, and assessment procedures and is ready to develop the IFSP with the family and appropriate agency personnel

Eligibility Determination • Questions?

Eligibility Determination